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Review
. 2022 Aug;18(8):1545-1564.
doi: 10.1002/alz.12511. Epub 2021 Dec 6.

Alzheimer's disease biomarkers in Black and non-Hispanic White cohorts: A contextualized review of the evidence

Carey E Gleason  1   2   3 , Megan Zuelsdorff  2   4 , Diane C Gooding  5   6 , Amy J H Kind  1   2   3   7 , Adrienne L Johnson  8 , Taryn T James  1   2 , Nickolas H Lambrou  3 , Mary F Wyman  3   5 , Fred B Ketchum  9 , Alexander Gee  10 , Sterling C Johnson  1   2   3 , Barbara B Bendlin  1   2 , Henrik Zetterberg  11   12   13   14   15
Affiliations
Review

Alzheimer's disease biomarkers in Black and non-Hispanic White cohorts: A contextualized review of the evidence

Carey E Gleason et al. Alzheimers Dement. 2022 Aug.

Abstract

Black Americans are disproportionately affected by dementia. To expand our understanding of mechanisms of this disparity, we look to Alzheimer's disease (AD) biomarkers. In this review, we summarize current data, comparing the few studies presenting these findings. Further, we contextualize the data using two influential frameworks: the National Institute on Aging-Alzheimer's Association (NIA-AA) Research Framework and NIA's Health Disparities Research Framework. The NIA-AA Research Framework provides a biological definition of AD that can be measured in vivo. However, current cut-points for determining pathological versus non-pathological status were developed using predominantly White cohorts-a serious limitation. The NIA's Health Disparities Research Framework is used to contextualize findings from studies identifying racial differences in biomarker levels, because studying biomakers in isolation cannot explain or reduce inequities. We offer recommendations to expand study beyond initial reports of racial differences. Specifically, life course experiences associated with racialization and commonly used study enrollment practices may better account for observations than exclusively biological explanations.

Keywords: AT(N) criteria; African American or Black; Alzheimer's disease biomarkers; cerebrospinal fluid and positron emission tomography amyloid; cerebrospinal fluid tau; racial disparities.

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Conflict of interest statement

CEG receives funding from the NIA‐NIH (R01 AG054059, RF1 AG027161, R01AG070883, RF1AG057784, P30 AG062715, AARF‐18‐562958). As a member of the Alzheimer's Association Scientific Program Committee, CEG receives support for travel to AAIC. CEG is a member of Executive Board for the Alzheimer's and Dementia Alliance of Wisconsin. MZ receives funding from NIA‐NIH (R03 AG063304, P30AG062715) and Alzheimer's Association (AARF‐18‐562958). MZ is Vice Chair of ISTAART Diversity & Disparities PIA. DCG is a board member of Society for Research in Psychopathology (SRP) and Schizophrenia International Research Society (SIRS). Additionally, DCG serves as Vice President of NAMI‐Dane County Board, Deputy Editor of Psychiatry Research (honorarium paid), and advisory board member of Black Leaders for Brain Health. AJHK receives funding from the National Institutes of Health National Institute on Aging and National Institute on Minority Health and Health Disparities and from the US Department of Veterans Affairs. AJHK has received speaking honoraria at a variety of US academic universities, as well as travel costs paid for by university academic entities for grand rounds presentations, visiting professorships, or external advisory committee work. AJL receives funding from ADRD Prevention Messaging to Increase Cessation Attempts in Older Adult Smokers (NIH‐NIA K23AG067929) and Wisconsin ADRC Developmental Project Award (NIH‐NIA P30AG534255). AJL is a Treatment Network–Educational subcommittee Co‐Chair for the Society for Research in Nicotine & Tobacco (SRNT) annual meetings. TTJ receives funding from NIA minority supplement: grant to the Institution. NHL has no conflicts of interest. MFW receives funding from the University of Wisconsin ICTR Pilot Funding Program. MFW was supported in part by fellowship funding from the US Department of Veterans Affairs. This content does not represent the views of the U.S. Department of Veterans Affairs or the United States Government. MFW has received financial support for the Vanderbilt University/Middle Tennessee Geriatrics Conference Keynote address, as an employee of Veteran Affairs, and as a trainee of the University of Wisconsin. MFW is involved in the Veterans Affairs Dementia Friendly Hospital Committee of the W.S. Middleton Memorial Veterans Hospital. FK has no conflicts of interest. AG has no conflicts of interest. SCJ receives funding from the NIH and Cerveau technologies to institution. SCJ serves on an advisory board for Roche Diagnostics. BBB receives funding from NIA‐NIH (R01AG070973, R01AG070883, R01AG062285, R01AG062285, R01AG059312, RF1AG057784, R01AG037639). BBB participated as DSMB chair for R21AG056882 Network‐Level Mechanisms for Preclinical Alzheimer's Disease Development, Levetiracetam (Keppra) Clinical Trial. BBB has received precursors and imaging agents from Avid Radiopharmaceuticals. HZ has served on scientific advisory boards for Denali, Roche Diagnostics, Wave, Samumed, Siemens Healthineers, Pinteon Therapeutics, and CogRx; has given lectures in symposia sponsored by Fujirebio, Alzecure, and Biogen; and is a co‐founder of Brain Biomarker Solutions in Gothenburg AB (BBS), which is a part of the GU Ventures Incubator Program (outside submitted work). HZ serves as chair of the Alzheimer's Association Biofluid Biomarker‐Based Professional Interest Area. HZ is a Wallenberg Scholar supported by grants from the Swedish Research Council (#2018‐02532), the European Research Council (#681712), Swedish State Support for Clinical Research (#ALFGBG‐720931), the Alzheimer Drug Discovery Foundation (ADDF), USA (#201809‐2016862), the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska‐Curie grant agreement No 860197 (MIRIADE), and the UK Dementia Research Institute at UCL.

Figures

FIGURE 1
FIGURE 1
Hypothetical model integrating the National Institute on Aging (NIA) Health Disparities Research Framework with the amyloid/tau/neurodegeneration (AT[N]) criteria from the NIA–Alzheimer's Assocation Research Framework. Evidence supporting individual examples association with Alzheimer's disease biomarkers is hypothetical in some instances. Examples are generally categorized as environmental, sociocultural, behavioral, or biological factors. However, we acknowledge that many examples can belong in multiple categories
See this image and copyright information in PMC

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